VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Spring Hill
8350 Mountain Larkspur Drive
Fairfax, VA 22079
(571) 348-4970

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: June 2, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 6/2/21 and concluded on 6/9/21. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 48. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed three resident records, three staff records, local fire and health inspections, and other documentation submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance with applicable standards or law, and violations were documented on the violation notice issued to the facility. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-260-A
Description:	Based on record review, the facility failed to ensure that each direct care staff member maintains certification in first aid. Each direct care staff member who does not have current certification in first aid shall receive certification in first aid within 60 days of employment. Evidence: The record for Staff #3, hired 6/15/20, as a medication aide, was reviewed during the inspection. The facility provided CPR certification for Staff #3 that was issued on 7/1/19. Staff #3's record did not contain documentation of first aid certification that was completed within 60 days of her employment. No additional documentation was provided by the facility.
Plan of Correction:	BOM or designee will ensure all new hired care staff maintain certification in first aid at the time of hire or obtain within 60 days of their hire date. The new class for first aid has been scheduled for June 22, 2021. Classes are being offered every 3 months to ensure compliance. The Executive Director or BOM is responsible for confirming implementation and ongoing compliance with the components of this plan of correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-73-320-A
Description:	Based on record review, the facility failed to ensure that each resident has a physical examination by an independent physician, within the 30 days preceding admission. The report shall include all of the required information. Evidence: The record for Resident #2, admitted 4/27/21 was observed during the inspection. Resident #2's physical examination, conducted 2/15/21, was completed more than 30 days before the resident was admitted. Resident #2's physical examination did not include information about the resident's ability to self-administer medication. The record for Resident #3, admitted 8/14/20, was observed during the inspection. Resident #3's physical examination, conducted 8/14/20, did not contain the resident's blood pressure reading.
Plan of Correction:	Sales and HCD will ensure that each resident has a physical examination by an independent physician within 30 days preceding admission. HCD will ensure the form is completed with all the pertinent information. Executive Director and a designee is responsible for confirming implementation and ongoing compliance with the components of this plan of correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-73-680-D
Description:	Based on record review, the facility failed to ensure that medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #3's May medication administration record (MAR) was reviewed during the inspection. Resident #3's Percocet order, dated 4/19/21, called for the resident to receive the medication every eight hours. The MAR indicated that Resident #3's Percocet was not administered on 5/10/21 (10 PM administration) or 5/11/21 (6 AM and 2 PM administrations).
Plan of Correction:	HCD or designee will perform daily checks on administration of all prescribed medications. HCD or designee will discuss any findings with ED during daily care meetings. HCD or designee will order medication from our pharmacy in an event, family is unable to provide medication in timely manner. Executive Director or designee is responsible for confirming implementation and ongoing compliance with the components of this plan of correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-90-40-B
Description:	Based on record review, the facility failed to obtain a criminal history record report, from the Department of State Police, within 30 days of hiring an employee. Evidence: The criminal history record reports, of new staff members, were reviewed during the inspection. The criminal history report for Staff #4, hired 10/16/20, was not provided during the inspection.
Plan of Correction:	BOM or designee will ensure to obtain a criminal history record report, from the Dept. of State Police within 30 days of hiring. Staff #4's BG has been completed. Executive Director or designee is responsible for confirming implementation and ongoing compliance with this plan of correction.